Review
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World J Gastrointest Endosc. Feb 16, 2010; 2(2): 61-68
Published online Feb 16, 2010. doi: 10.4253/wjge.v2.i2.61
Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures
Rakesh Kochhar, Kuchhangi Suresh Poornachandra
Rakesh Kochhar, Kuchhangi Suresh Poornachandra, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Kochhar R conceived and designed the review, reviewed the literature and prepared the manuscript; Poornachandra KS reviewed the literature and prepared the manuscript.
Correspondence to: Rakesh Kochhar, Professor, Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. dr_kochhar@hotmail.com
Telephone: +91-172-2715016 Fax: +91-172-2744401
Received: April 11, 2009
Revised: September 7, 2009
Accepted: September 15, 2009
Published online: February 16, 2010
Abstract

Esophageal strictures are a problem frequently encountered by gastroenterologists. Dilation has been the customary treatment for benign esophageal strictures, and dilation techniques have advanced over the years. Depending on their characteristics and the response to treatment, esophageal strictures can be classified into two types: 1, simple (Schatzki rings, webs, peptic injury, and following sclerotherapy) - these are easily amenable to dilation, with a low recurrence rate after initial treatment; and 2, complex (caused by caustic ingestion, radiation injury, anastomotic strictures, and photodynamic therapy) - these are difficult to dilate and are associated with higher recurrence rates. Refractory strictures are those in which it is not possible to relieve the anatomic restriction successfully up to a diameter of 14 mm over five sessions at 2-weekly intervals, due to cicatricial luminal compromise or fibrosis; and recurrent strictures are those in which it is not possible to maintain a satisfactory luminal diameter for 4 wk once the target diameter of 14 mm has been achieved. There are no standard recommendations for the management of refractory strictures. The various techniques used include intralesional steroid injection combined with dilation; endoscopic incisional therapy, with or without dilation; placement of self-expanding metal stents, Polyflex stents, or biodegradable stents; self-bougienage; and endoscopic surgery. This review discusses the indications, technique, results, and complications of the use of intralesional steroid injections combined with dilation and endoscopic incisional therapy with dilation in refractory strictures.

Keywords: Gastrointestinal strictures; Intralesional injection; Triamcinolone; Steroids; Dilation; Endoscopy